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Open Supracondylar Humerus Fractures in Children

Purpose: Supracondylar humerus (SCH) fractures are the most common elbow fracture in children; however, they rarely occur as open injuries. Open fractures are associated with higher rates of infection, neurovascular injury, compartment syndrome, and nonunion. The purpose of this study was to evaluat...

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Autores principales: Pan, Tommy, Widner, Matthew R, Chau, Michael M, Hennrikus, William L
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8046429/
https://www.ncbi.nlm.nih.gov/pubmed/33880259
http://dx.doi.org/10.7759/cureus.13903
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author Pan, Tommy
Widner, Matthew R
Chau, Michael M
Hennrikus, William L
author_facet Pan, Tommy
Widner, Matthew R
Chau, Michael M
Hennrikus, William L
author_sort Pan, Tommy
collection PubMed
description Purpose: Supracondylar humerus (SCH) fractures are the most common elbow fracture in children; however, they rarely occur as open injuries. Open fractures are associated with higher rates of infection, neurovascular injury, compartment syndrome, and nonunion. The purpose of this study was to evaluate the treatment and outcomes of open SCH fractures in children. Methods: Between 2008 and 2015, four children (1%) had open injuries among 420 treated for SCH fractures at a single center. The mean patient age was six years (range, four to eight years). Two patients had Gustilo-Anderson grade 1 open fractures and two had grade 2 fractures. Tetanus immunization was up-to-date in all. First dose of intravenous antibiotics was given on average 3hr 7min after onset of injury (range, 1hr 38min to 8hr 15min). Time from injury to irrigation and debridement (I&D) and closed reduction and percutaneous pinning (CRPP) was on average 8hr 16min (range, 4hr 19min to 13hr 15min). All patients received 24-hour intravenous antibiotics. Pins were removed at four weeks and bony union occurred by six weeks. Results: After an average follow-up period of 12 months (range, 6 to 22 months), there were no infections, neurovascular deficits, compartment syndromes, cubitus varus deformities, or range of motion losses. All outcomes were excellent according to the Flynn criteria. Due to the unstable nature of open SCH fractures, a medial pin was used in all four cases. No loss of reduction or ulnar nerve injury occurred. Conclusion: Open injuries occur in approximately 1% of all SCH fractures in children. The authors recommend urgent intravenous antibiotics, I&D, and CRPP involving a medial pin to treat open SCH fractures. Excellent outcomes based on the Flynn criteria were obtained in four cases.
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spelling pubmed-80464292021-04-19 Open Supracondylar Humerus Fractures in Children Pan, Tommy Widner, Matthew R Chau, Michael M Hennrikus, William L Cureus Pediatrics Purpose: Supracondylar humerus (SCH) fractures are the most common elbow fracture in children; however, they rarely occur as open injuries. Open fractures are associated with higher rates of infection, neurovascular injury, compartment syndrome, and nonunion. The purpose of this study was to evaluate the treatment and outcomes of open SCH fractures in children. Methods: Between 2008 and 2015, four children (1%) had open injuries among 420 treated for SCH fractures at a single center. The mean patient age was six years (range, four to eight years). Two patients had Gustilo-Anderson grade 1 open fractures and two had grade 2 fractures. Tetanus immunization was up-to-date in all. First dose of intravenous antibiotics was given on average 3hr 7min after onset of injury (range, 1hr 38min to 8hr 15min). Time from injury to irrigation and debridement (I&D) and closed reduction and percutaneous pinning (CRPP) was on average 8hr 16min (range, 4hr 19min to 13hr 15min). All patients received 24-hour intravenous antibiotics. Pins were removed at four weeks and bony union occurred by six weeks. Results: After an average follow-up period of 12 months (range, 6 to 22 months), there were no infections, neurovascular deficits, compartment syndromes, cubitus varus deformities, or range of motion losses. All outcomes were excellent according to the Flynn criteria. Due to the unstable nature of open SCH fractures, a medial pin was used in all four cases. No loss of reduction or ulnar nerve injury occurred. Conclusion: Open injuries occur in approximately 1% of all SCH fractures in children. The authors recommend urgent intravenous antibiotics, I&D, and CRPP involving a medial pin to treat open SCH fractures. Excellent outcomes based on the Flynn criteria were obtained in four cases. Cureus 2021-03-15 /pmc/articles/PMC8046429/ /pubmed/33880259 http://dx.doi.org/10.7759/cureus.13903 Text en Copyright © 2021, Pan et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Pediatrics
Pan, Tommy
Widner, Matthew R
Chau, Michael M
Hennrikus, William L
Open Supracondylar Humerus Fractures in Children
title Open Supracondylar Humerus Fractures in Children
title_full Open Supracondylar Humerus Fractures in Children
title_fullStr Open Supracondylar Humerus Fractures in Children
title_full_unstemmed Open Supracondylar Humerus Fractures in Children
title_short Open Supracondylar Humerus Fractures in Children
title_sort open supracondylar humerus fractures in children
topic Pediatrics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8046429/
https://www.ncbi.nlm.nih.gov/pubmed/33880259
http://dx.doi.org/10.7759/cureus.13903
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